Knife Edge Ridge in Implant Treatment: Can I Do a Ridge Split and Bone Graft?

Dear Dr, Forget about one-stage implantation in this case... First, augment existing bone. After 5-6 months, install the implants. Neda Moslemi

Here scan the case to get a more helpful image , ridge splitiing well is difficult so if you have not done many this may be a difficult case to start . Another option is the garage door technique as show by Dr.Dr. Fuchs of Switzerland , but again technique sensitive. Maybe refer?

Dr.B You,Sir, are having us on!

this cannot be a real question

Need good CT scan. Even if you augmented the width, what about the height? This is advnaced bone grafting case, reffer !

Block graft from ramus or chin to augment width. Vertical height of the mandible is the hardest to achieve. You will need some extra height to place implants in the area. First make sure you really have 6-7 mm, as a panorex will magnify an image 20-25% You can try cancellous particles with a titanium mesh, results can be mixed. You can also try to place a 8mm implant, leaving the collar exposed 2 mm, and graft that. Place a membrane over it and wait 6 months. I have had good results with that. Usually the bone will actually grow over the implant. This is a difficult case. Please keep in mind that some cases just can't be done, even with extensive BG.

I don't mean to sound offensive, but if you're asking this question, then you shouldn't be doing this procedure. The height of bone above the IAN alone, dictates referral to someone who is comfortable with major bone grafting. In regards to ridge splitting, you stated that there is no ridge width, i.e. knife edge. Refer this one out, or seek a different restorative game plan.

Not going to happen my friend. like everyone else , I agree that you are not being realistic here. There probably isn't enough medulary bone for any type of graft here . Don't even think about ridge splitting . Refer out or other options than implants.

reduce aveolar bone and go with a unilateral sub. conect to teeth anterior.

Dr B: It is hard not to sound critical when asked a question like this. You need to start with your treatment plan: If you have 6 to 7 mm from the crest of the ridge to the inferior alveolar nerve on a panoramic (which generally have about 15% magnification or more) that tells you that the longest implant you can place is about 4mm (I don't think they make them that small). Also, if you have to go and use a short implant, it is recommended to use a wide diameter, especially in the molar region, and you don't have the width either, since you need about 1.5 to 2mm of bone on the buccal and lingual of the implant if you don't want to loose the bone after the implant is placed. A blade may be possible, but very few implantologists do blades today. If you have to augment, it would require an onlay autologous graft and you should explain the options to the patient and refer. Good luck and I hope this helps.

There is a saying in hot air ballooning- "Sometimes it is better to be on the ground wishing you were in the air than to be in the air wishing you were on the ground." As stated previously, this is a very challenging case, one for which there is no guarantee that the clinical objective will be reached. Do you have the experience to treat this patient, not just initially, but for the inevitable complications that may occur? I suspect by your question that you may not. Just being realistic here. I would either refer or change your treatment plan. If you proceed, you must carefully document that the patient understands the risks of this treatment. Remember, if you provide the treatment, you will be held to the same standard of care as someone who has the training and significant experience with this type of clinical challenge.

Dear Dr.B Please do not try bone splıttıng.Keepıng in mind the strict rules of GBR augment the ridge by a block graft taken from the anterior mandible.But for the nutrition of the graft and the allograft you need to decorticate the buccal side of the knife ridge which means to destroy the zone.So I think it will be better to reduce the height of the ridge till you reach the spongious bone and then you can fix the graft and use the filed bone pieces as a cotouring material please use a late absorbabl membrane over the grafted side.Wait for 3-4months.Then evaluate the area by a CT scan.Keeping in mind the boundries of zone of safety( Dr. Misch)you can then ınstall 1-2 ımplants .Please wait for osseointegration at least for 4 months or more. If you do not have enough experience to do this procedures have someone do ıt for you. Good Luck

If this is a distal extension case they simply place two unilateral subs and call it a day.

I think that after a really good images evaluation the right technique is the one that Dr. M. Pikos described on 2.000. A bone graft from chin or ramus and on a second stage place the implants.

Dear Colleague; For solve your problem ' you have to do 3D bone augmentation;with ramus or chin bone graft.After almost 5-6 mounth you can make implant instalation. Take care and open your eyes.

Dear Dr. B, Whilst I agree with my other collegues about the 3D scan (I have the Kodak 9000 3D cone beam machine), I would strongly suggest that you visit Bicon's website. They have many videos and recorded Webinars including some by Dr. Shadi Daher demonstrating their two stage ridge split technique. You should be able to place 5mm x 5mm Bicon Short Implants using these techniques with the caveat of your level of experience. Time will be greatly reduced along with no need for chin grafts, etc. Fwiw, Bill Ingram

Dear Dr, I would consider a homologous reconstruction.Have done some very nice cases. You should really think about it. Regards,

`I admire your taking on a challenge and expanding your experience with this problem. I am interested in the outcome myself due to living in Orlando with a lot of thin ridges. I have been using a screw device through a base plate guide so that I can expand (no drilling or hammering) and stay precise on the angle and the depth.

What is difference between normal & split dental implant. What are disadvantages of split implants. Do we have the technology for split implant ??

Knife ridge should be treated with: 1. Relining soft material. 2. Maximum coverage of flange. 3. Wide occlusal Table